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HIPAA CLAIM DENIAL SEARCH:

 
Search by Hipaa Claim Denial Code:
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You searched for : Hipaa Claim Denial :

Code : 1
Description : Deductible Amount
Code : 2
Description : Coinsurance Amount
Code : 3
Description : Co-payment Amount
Code : 4
Description : The procedure code is inconsistent with the modifier used or a required modifier is missing
Code : 5
Description : The procedure code/bill type is inconsistent with the place of service
Code : 6
Description : The procedure/revenue code is inconsistent with the patient's age
Code : 7
Description : The procedure/revenue code is inconsistent with the patient's gender
Code : 8
Description : The procedure code is inconsistent with the provider type/specialty (taxonomy)
Code : 9
Description : The diagnosis is inconsistent with the patient's age
Code : 10
Description : The diagnosis is inconsistent with the patients gender
Code : 11
Description : The diagnosis is inconsistent with the procedure
Code : 12
Description : The diagnosis is inconsistent with the provider type
Code : 13
Description : The date of death precedes the date of service
Code : 14
Description : The date of birth follows the date of service
Code : 15
Description : Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider
Code : 16
Description : Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate
Code : 17
Description : Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate
Code : 18
Description : Duplicate claim/service
Code : 19
Description : Claim denied because this is a work-related injury/illness and thus the liability of the Workers Compensation Carrier
Code : 20
Description : Claim denied because this injury/illness is covered by the liability carrier
Code : 21
Description : Claim denied because this injury/illness is the liability of the no-fault carrier
Code : 22
Description : Payment adjusted because this care may be covered by another payer per coordination of benefits
Code : 23
Description : Payment adjusted because charges have been paid by another payer
Code : 24
Description : Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan
Code : 25
Description : Payment denied. Your Stop loss deductible has not been met
Code : 26
Description : Expenses incurred prior to coverage
Code : 27
Description : Expenses incurred after coverage terminated
Code : 28
Description : The time limit for filing has expired
Code : 29
Description : The time limit for filing has expired
Code : 30
Description : Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements
Code : 31
Description : Claim denied as patient cannot be identified as our insured
Code : 32
Description : Our records indicate that this dependent is not an eligible dependent as defined
Code : 33
Description : Claim denied. Insured has no dependent coverage
Code : 34
Description : Claim denied. Insured has no coverage for newborns
Code : 35
Description : Lifetime benefit maximum has been reached
Code : 38
Description : Services not provided or authorized by designated (network/primary care) providers
Code : 39
Description : Services denied at the time authorization/pre-certification was requested
Code : 40
Description : Charges do not meet qualifications for emergent/urgent care
Code : 42
Description : Charges exceed our fee schedule or maximum allowable amount
Code : 43
Description : Gramm-Rudman reduction
Code : 44
Description : Prompt-pay discount
Code : 45
Description : Charges exceed your contracted/ legislated fee arrangement
Code : 47
Description : This (these) diagnosis(es) is (are) not covered, missing, or are invalid
Code : 49
Description : These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam
Code : 50
Description : These are non-covered services because this is not deemed a medical necessity by the payer
Code : 51
Description : These are non-covered services because this is a pre-existing condition
Code : 52
Description : The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed
Code : 53
Description : Services by an immediate relative or a member of the same household are not covered
Code : 54
Description : Multiple physicians/assistants are not covered in this case
Code : 55
Description : Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer
Code : 56
Description : Claim/service denied because procedure/treatment has not been deemed proven to be effective by the payer
Code : 57
Description : Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this days supply
Code : 58
Description : Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service
Code : 59
Description : Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules
Code : 60
Description : Charges for outpatient services with this proximity to inpatient services are not covered
Code : 61
Description : Charges adjusted as penalty for failure to obtain second surgical opinion
Code : 62
Description : Payment denied/reduced for absence of, or exceeded, pre-certification/authorization
Code : 66
Description : Blood Deductible
Code : 69
Description : Day outlier amount
Code : 70
Description : Cost outlier - Adjustment to compensate for additonal costs
Code : 74
Description : Indirect Medical Education Adjustment
Code : 75
Description : Direct Medical Education Adjustment
Code : 76
Description : Disproportionate Share Adjustment
Code : 78
Description : Non-Covered days/Room charge adjustment
Code : 85
Description : Interest amount
Code : 87
Description : Transfer amount
Code : 88
Description : Adjustment amount represents collection against receivable created in prior overpayment
Code : 89
Description : Professional fees removed from charges
Code : 90
Description : Ingredient cost adjustment
Code : 91
Description : Dispensing fee adjustment
Code : 94
Description : Processed in Excess of charges
Code : 95
Description : Benefits adjusted. Plan procedures not followed
Code : 96
Description : Non-covered charge(s)
Code : 97
Description : Payment is included in the allowance for another service/procedure
Code : 100
Description : Payment made to patient/insured/responsible party
Code : 101
Description : Predetermination: anticipated payment upon completion of services or claim adjudication
Code : 102
Description : Major Medical Adjustment
Code : 103
Description : Provider promotional discount (e.g., Senior citizen discount)
Code : 104
Description : Managed care withholding
Code : 105
Description : Tax withholding
Code : 106
Description : Patient payment option/election not in effect
Code : 107
Description : Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim
Code : 108
Description : Payment adjusted because rent/purchase guidelines were not met
Code : 109
Description : Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor
Code : 110
Description : Billing date predates service date
Code : 111
Description : Not covered unless the provider accepts assignment
Code : 112
Description : Payment adjusted as not furnished directly to the patient and/or not documented
Code : 113
Description : Payment denied because service/procedure was provided outside the United States or as a result of war
Code : 114
Description : Procedure/product not approved by the Food and Drug Administration
Code : 115
Description : Payment adjusted as procedure postponed or canceled
Code : 116
Description : Payment denied. The advance indemnification notice signed by the patient did not comply with requirements
Code : 117
Description : Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care
Code : 118
Description : Charges reduced for ESRD network support
Code : 119
Description : Benefit maximum for this time period or occurrence has been reached
Code : 120
Description : Patient is covered by a managed care plan
Code : 121
Description : Indemnification adjustment
Code : 122
Description : Psychiatric reduction
Code : 123
Description : Payer refund due to overpayment
Code : 124
Description : Payer refund amount - not our patient
Code : 125
Description : Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate
Code : 126
Description : Deductible  Major Medical
Code : 127
Description : Coinsurance  Major Medical
Code : 128
Description : Newborns services are covered in the mothers Allowance
Code : 129
Description : Payment denied - Prior processing information appears incorrect
Code : 130
Description : Claim submission fee
Code : 131
Description : Claim specific negotiated discount
Code : 132
Description : Prearranged demonstration project adjustment
Code : 133
Description : The disposition of this claim/service is pending further review
Code : 134
Description : Technical fees removed from charges
Code : 135
Description : Claim denied. Interim bills cannot be processed
Code : 136
Description : Claim Adjusted. Plan procedures of a prior payer were not followed
Code : 137
Description : Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes
Code : 138
Description : Claim/service denied. Appeal procedures not followed or time limits not met
Code : 139
Description : Contracted funding agreement - Subscriber is employed by the provider of services
Code : 140
Description : Patient/Insured health identification number and name do not match
Code : 141
Description : Claim adjustment because the claim spans eligible and ineligible periods of coverage
Code : 142
Description : Claim adjusted by the monthly Medicaid patient liability amount
Code : 143
Description : Portion of payment deferred
Code : 144
Description : Incentive adjustment, e.g. preferred product/service
Code : 145
Description : Premium payment withholding
Code : 146
Description : Payment denied because the diagnosis was invalid for the date(s) of service reported
Code : 147
Description : Provider contracted/negotiated rate expired or not on file
Code : 148
Description : Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete
Code : 149
Description : Lifetime benefit maximum has been reached for this service/benefit category
Code : 150
Description : Payment adjusted because the payer deems the information submitted does not support this level of service
Code : 151
Description : Payment adjusted because the payer deems the information submitted does not support this many services
Code : 152
Description : Payment adjusted because the payer deems the information submitted does not support this length of service
Code : 153
Description : Payment adjusted because the payer deems the information submitted does not support this dosage
Code : 154
Description : Payment adjusted because the payer deems the information submitted does not support this days supply
Code : 155
Description : This claim is denied because the patient refused the service/procedure
Code : 156
Description : Flexible spending account payments
Code : 157
Description : Payment denied/reduced because service/procedure was provided as a result of an act of war
Code : 158
Description : Payment denied/reduced because the service/procedure was provided outside of the United States
Code : 159
Description : Payment denied/reduced because the service/procedure was provided as a result of terrorism
Code : 160
Description : Payment denied/reduced because injury/illness was the result of an activity that is a benefit exclusion
Code : 161
Description : Provider performance bonus
Code : 162
Description : State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation
Code : 163
Description : Claim/Service adjusted because the attachment referenced on the claim was not received
Code : 164
Description : Claim/Service adjusted because the attachment referenced on the claim was not received in a timely fashion.
Code : 165
Description : Payment denied /reduced for absence of, or exceeded referral
Code : 166
Description : These services were submitted after this payers responsibility for processing claims under this plan ended
Code : 167
Description : This (these) diagnosis(es) is (are) not covered
Code : 168
Description : Payment denied as Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan
Code : 169
Description : Payment adjusted because an alternate benefit has been provided
Code : 170
Description : Payment is denied when performed/billed by this type of provider
Code : 171
Description : Payment is denied when performed/billed by this type of provider in this type of facility
Code : 172
Description : Payment is adjusted when performed/billed by a provider of this specialty
Code : 173
Description : Payment adjusted because this service was not prescribed by a physician
Code : 174
Description : Payment denied because this service was not prescribed prior to delivery
Code : 175
Description : Payment denied because the prescription is incomplete
Code : 176
Description : Payment denied because the prescription is not current
Code : 177
Description : Payment denied because the patient has not met the required eligibility requirements
Code : 178
Description : Payment adjusted because the patient has not met the required spend down requirements
Code : 179
Description : Payment adjusted because the patient has not met the required waiting requirements
Code : 180
Description : Payment adjusted because the patient has not met the required residency requirements
Code : 181
Description : Payment adjusted because this procedure code was invalid on the date of service
Code : 182
Description : Payment adjusted because the procedure modifier was invalid on the date of service
Code : 183
Description : The referring provider is not eligible to refer the service billed
Code : 184
Description : The prescribing/ordering provider is not eligible to prescribe/order the service billed
Code : 185
Description : The rendering provider is not eligible to perform the service billed
Code : 186
Description : Payment adjusted since the level of care changed
Code : 187
Description : Health Savings account payments
Code : 188
Description : This product/procedure is only covered when used according to FDA recommendations
Code : 189
Description : "Not otherwise classified" or "unlisted" procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service
Code : 190
Description : Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay
Code : 191
Description : Claim denied because this is not a work related injury/illness and thus not the liability of the workers compensation carrier.
Code : 192
Description : Non standard adjustment code from paper remittance advice
Code : 193
Description : Original payment decision is being maintained. This claim was processed properly the first time
Code : 194
Description : Payment adjusted when anesthesia is performed by the operating physician, the assistant surgeon or the attending physician
Code : 195
Description : Payment denied/reduced due to a refund issued to an erroneous priority payer for this claim/service
Code : A0
Description : Patient refund amount
Code : A1
Description : Claim denied charges
Code : A2
Description : Contractual adjustment
Code : A4
Description : Medicare Claim PPS Capital Day Outlier Amount
Code : A5
Description : Medicare Claim PPS Capital Cost Outlier Amount
Code : A6
Description : Prior hospitalization or 30 day transfer requirement not met
Code : A7
Description : Presumptive Payment Adjustment
Code : A8
Description : Claim denied; ungroupable DRG
Code : B1
Description : Non-covered visits
Code : B4
Description : Late filing penalty
Code : B5
Description : Payment adjusted because coverage/program guidelines were not met or were exceeded
Code : B6
Description : This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty
Code : B7
Description : This provider was not certified/eligible to be paid for this procedure/service on this date of service
Code : B8
Description : Claim/service not covered/reduced because alternative services were available, and should have been utilized
Code : B9
Description : Services not covered because the patient is enrolled in a Hospice
Code : B10
Description : Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test
Code : B11
Description : The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor
Code : B12
Description : Services not documented in patients medical records
Code : B13
Description : Previously paid. Payment for this claim/service may have been provided in a previous payment
Code : B14
Description : Payment denied because only one visit or consultation per physician per day is covered
Code : B15
Description : Payment adjusted because this procedure/service is not paid separately
Code : B16
Description : Payment adjusted because New Patient qualifications were not met
Code : B17
Description : Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current
Code : B18
Description : Payment denied because this procedure code/modifier was invalid on the date of service or claim submission
Code : B20
Description : Payment adjusted because procedure/service was partially or fully furnished by another provider
Code : B22
Description : This payment is adjused based on the diagnosis
Code : B23
Description : Payment denied because this provider has failed an aspect of a proficiency testing program
Code : D21
Description : This (these) diagnosis(es) is (are) missing or are invalid
Code : W1
Description : Workers Compensation State Fee Schedule Adjustment


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